Cardiothoracic Surgery

Mechanical Assist Devices and Total Artificial Heart

Pauley Heart Center surgeons and heart failure specialists are at the forefront of medical and surgical treatment of late stage heart failure. Treatment options beyond medicines and special pacemakers for patients with advanced heart failure include heart transplantation, ventricular assist devices (VADs) and the temporary-Total Artificial Heart (t-TAH).

Although heart transplantation has long been recognized as the ideal treatment for patients with severe heart failure, donor hearts are a rare and limited resource. VADs and the t-TAH have revolutionized treatment of advanced heart failure, providing life-saving and quality-of-life options for advanced heart failure patients.

Ventricular Assist Devices

A VAD is a mechanical pump that does not replace the heart; rather, it helps the heart pump blood to the body. For a heart transplant candidate, the device may allow the patient to safely survive until a donor heart becomes available, in which case it is referred to as a “bridge-to-transplantation.” Alternatively, patients who are not candidates for heart transplant may be considered for VAD “destination therapy” to improve symptoms and quality of life. A VAD can provide symptom relief for years.

In 2008, The Joint Commission awarded VCU Medical Center’s VAD program with the Gold Seal of Approval™ for excellence in the areas of patient safety, satisfaction and outcomes. The award recognizes our on-going commitment to quality care for patients with advanced heart failure.

Total Artificial Heart

For heart transplant candidates that cannot be treated with a VAD, a t-TAH may be implanted. The t-TAH replaces the entire failing heart, providing clinical stability until a donor heart becomes available.

In April 2006, VCU’s cardiac surgery team performed the first t-TAH implant on the East Coast. Since then, we have implanted over 40 t-TAH’s. Currently, VCU Pauley Heart Center is the most active t-TAH center in the United States.

In the hospital, t-TAH patients reside in a dedicated device unit focused on nutrition and physical conditioning, which includes riding stationary bicycles, treadmills and light weight lifting. Traditionally, t-TAH patients were tethered to a 400 lb device driver that kept them hospitalized until a donor heart became available. The waiting period for a heart transplant, however, is unpredictable and can last many months. In a landmark clinical trial underway at Pauley Heart Center, the 15 lb “Freedom Driver” allows patients to return home until a donor heart becomes available.